Healthcare Provider Details

I. General information

NPI: 1376532390
Provider Name (Legal Business Name): AMY L BEAUPRE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 10/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 OLD ETNA RD DARTMOUTH HITCHCOCK - PRIMARY CARE
LEBANON NH
03766-1937
US

IV. Provider business mailing address

18 OLD ETNA RD DARTMOUTH HITCHCOCK - PRIMARY CARE
LEBANON NH
03766-1937
US

V. Phone/Fax

Practice location:
  • Phone: 603-650-4000
  • Fax:
Mailing address:
  • Phone: 603-650-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number046404-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: